The usefulness of
icodextrin-containing
peritoneal dialysis (PD)
solution for the management of body fluid and blood pressure has been reported. However,
icodextrin PD
solution is a foreign
solution in the body, and the possible induction of intraperitoneal
inflammation has been reported. In this study, we investigated at 6-month intervals the influence of
icodextrin solution on peritoneal permeability and inflammatory reactions in patients in whom
glucose solution had been changed to
icodextrin solution for the overnight dwell. We enrolled 9 anuric PD patients (5 men, 4 women) of mean age 58 +/- 5.9 years (range: 45.6-64.8 years) into the study. The patients' mean duration of PD was 61.9 +/- 42 months (range: 6.7-142.5 months). The cause of
end-stage renal disease was chronic
glomerulonephritis in all patients. For evaluation ofperitoneal permeability, we performed peritoneal equilibration tests (PETs) immediately after an overnight dwell and determined the
dialysate-to-plasma ratios of
creatinine (D/P Cr), beta2-microglobulin (D/P beta2m),
albumin (D/P Alb),
immunoglobulin G (D/P
IgG), and
alpha2-macroglobulin (D/P alpha2m). We also measured
interleukin-6 (IL-6) and
fibrinogen degradation products (FDPs) in overnight effluent as indices of
inflammation and of the fibrinolysis-coagulation system. The evaluation was performed every 6 months for 24 months. The FDPs in effluent increased significantly at 6 months after the change to
icodextrin solution, and
IL-6 tended to increase. The D/P beta2m, D/P Alb, D/P
IgG, and D/P alpha2m all significantly increased in the course of follow-up. In the PETs, the D/P Cr increased slightly, but the change was nonsignificant. At 30 months after the change to
icodextrin solution, 1 patient was diagnosed as having a risk of
encapsulating peritoneal sclerosis (pre-EPS). In this patient, rapid increases in
IL-6, D/P Cr and macromolecular and small molecular D/P by PET were noted after the change to
icodextrin solution.
Steroids were administered after the diagnosis of pre-EPS, with the result that the
IL-6 level rapidly decreased and the D/P Cr and D/P of small molecules and macromolecules slightly decreased.
Icodextrin dialysis solution increased peritoneal permeability. Although the cause was unclear,
icodextrin may have changed peritoneal reactivity. Long-term use of
icodextrin PD
solution requires further investigation.